Method, system and computer program product for detecting and preventing fraudulent health care claims

A computer-implemented method of detecting a fraudulent health care claim for a payment for a health care service, said method comprising:

• generating, by a first computing unit controlled by a health care claim verification entity (CVE), an encrypted bar code that includes a set of bar code data that identifies a plurality of health care transactions (transactions), wherein said bar code data includes a service date and an identification code (provider ID) of a health care service provider (provider) that is requested to provide a plurality of health care services to a plurality of clients on said service date, wherein said plurality of transactions includes a transaction that indicates that said provider is requested to provide, on said service date, a health care service (service) of said plurality of health care services to a client of said plurality of clients;
• storing, by said first computing unit and subsequent to said generating said bar code, said bar code in a computer data file;
• posting, by said first computing unit and subsequent to said storing said bar code, said computer data file to a website controlled by said CVE and accessible by a second computing unit controlled by said provider;
• sending said computer data file that stores said bar code to said second computing unit via an access of said website by said second computing unit;
• printing, by said second computing unit and subsequent to said sending said computer data file that stores said bar code, a transaction document that includes said bar code and a plurality of data entry areas for receiving a set of transaction data that describes said transaction;
• receiving, by said first computing unit and subsequent to said printing, a digital image file that includes said bar code data, said set of transaction data received in said plurality of data entry areas and a signature that indicates said client;
• extracting, by said first computing unit and subsequent to said receiving said digital image file, said bar code data, said signature, and said set of transaction data from said digital image file;
• determining, by a signature verification engine executing on said first computing unit and subsequent to said extracting, a score that indicates whether said extracted signature matches a reference signature that is stored in a database residing in a computer data storage unit, wherein said database associates said reference signature with said client;
• generating, by said first computing unit and if said score does not satisfy a set of predefined criteria for matching said extracted signature to said reference signature, a first report that includes a first type of said fraudulent health care claim, wherein said first type indicates a billing for said service by said provider, but said service is not provided to said client by said provider;
• searching said database, by said first computing unit and subsequent to said extracting, for a match between a group of extracted data and a transaction record of a plurality of transaction records stored in said database prior to said generating said bar code, wherein said group of extracted data includes said extracted set of transaction data and said extracted bar code data, wherein said match includes an identifier of said client included in said extracted set of transaction data matching a client identifier in said transaction record, said extracted service date included in said extracted bar code data matching a date in said transaction record, and said extracted provider ID included in said extracted bar code data matching a provider identifier in said transaction record;
• identifying, in response to said searching, that said match is absent;
• and
• generating, by said first computing unit and in response to said identifying, a second report that includes a second type of said fraudulent health care claim, wherein said second type indicates a billing for said service, but said service provided by said provider to said client on said service date is not authorized by any transaction record of said plurality of transaction records.

A computer-implemented method of verifying a claim for a payment for a health care service, said method comprising:

• generating, by a first computing unit controlled by a health care claim verification entity (CVE), an encrypted bar code (bar code) that includes a set of bar code data that identifies a health care transaction (transaction), wherein said bar code data includes a service date and an identification code (provider ID) of a health care service provider (provider) that provides a health care service (service) to a client on said service date;
• receiving, by said first computing unit and subsequent to said generating said bar code, a digital image file that includes said bar code, a set of transaction data that describes said transaction, and a signature that is initially handwritten by said client;
• extracting, by said first computing unit and subsequent to said receiving said digital image file, said set of transaction data and said signature from said digital image file;
• extracting, by said first computing unit and subsequent to said receiving said digital image file, said provider ID and said service date from said bar code included in said digital image file;
• determining, by said first computing unit and subsequent to said extracting said set of transaction data and said signature, that said extracted signature matches a reference signature that is stored in a database that associates said reference signature with said client;
• determining that a group of extracted data is included in a transaction record of a plurality of transaction records stored in said database prior to said generating said bar code, wherein said group of extracted data includes said extracted service date, said extracted provider ID, and an identifier of said client, wherein said identifier of said client is included in said extracted set of transaction data;
• and
• generating, by said first computing unit, in response to said determining that said group of extracted data is included in said transaction record and in response to said determining that said extracted signature matches said reference signature, a report that verifies a claim for a payment of said service.